The Institute for Medical Simulation and Advanced Learning (IMSAL), HHC’s comprehensive training center has already trained more than 3,000 physicians, nurses and other technicians to master skills, work better as teams, and practice challenging emergency procedures to improve patient safety and patient care. Katie Walker, RN, the new Director of IMSAL, and a national leader in medical simulation, talks about the growing importance of simulation training, the latest innovations at IMSAL, and her plans for the future.
What's happening in healthcare simulation across the country and the world?
There is a groundswell of activity in the healthcare simulation world. In the U.S., where highly immersive simulation began in the late 80’s, there is now a tsunami of both medical and nursing schools and hospital systems, both public and private, embracing simulation as a teaching technique. In January 2012, The Society for Simulation in Healthcare (SSH) - the largest international healthcare simulation member organization - held its International Meeting in San Diego and broke attendance records. There were over 3,100 educators, researchers and exhibitors from 37 countries represented. As simulation training expands, there is an emphasis on developing educators who deeply understand simulation and its applications. At HHC, we are lucky to already have a skilled instructional team who can share their teaching skills and can maximize the simulation learning experience for our physicians and nurses.
You had such a successful career in Australia. What convinced you to join HHC and move to New York City?
When I was on my Churchill Fellowship in 2007, it was obvious to me that the expertise in simulation research in the world was located in the USA, and particularly in the Northeast. When I heard about the HHC position and started reading about HHC, I knew I wanted to be here. I just loved the HHC ethos and how it cares for such a large diverse population, including more than 475,000 people who are uninsured. I felt that I could use the skills and knowledge that I had gained from developing large simulation programs, both on a state and national level, to advance the program in New York City. I feel privileged to work with such an amazingly dedicated staff and I’m confident the IMSAL program we can make a difference to patient care.
The Institute has trained more than 3,000 HHC staff so far. Who are these staff members and what have they learned?
We have focused on training mainly teams of physicians and nurses. We have chosen a curriculum that we think will make the most difference to patient care by using advice from experts and data collected in the areas of patient safety and quality indicators. Our current courses include central line placement, advanced and basic airway skills, cardiac code team and maternal emergencies such as shoulder dystocia. We have four courses in development for pediatrics and behavioral health and we hope to incorporate patient actors in the near future to help improve bedside manner.
Why have you focused your attention on team training?
We know that communication failure is a primary cause in nearly 80 percent of reported medical errors. Healthcare delivery is such a complex system, and although everyone sets out to do their best for their patients, good communication in this environment needs to be taught. For any one patient there are always multiple healthcare professionals involved in their care. That means the communication among the members of that care team is critical to deliver the patient-centered and safe care we want to provide.
How do you teach improved communications skills?
A popular method we use to strategize and motivate are huddles – a simple concept where the entire team comes together for a moment or longer, as needed, to clarify team roles and responsibilities, resolve conflict, and eliminate barriers to quality and safety for our patients. Huddles have been adopted by Army medical teams and now by IMSAL to improve communications and produce highly effective teams. The use of huddles is part of the scientifically proven teamwork system called TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) developed by the U.S. Department of Defense and the Agency for Healthcare Research and Quality (AHRQ) to help healthcare professionals optimize the use of information, people and resources, and achieve the best clinical outcomes for patients.
How is IMSAL different from other healthcare simulation programs?
Most medical simulation programs out there are only training medical students on an individual basis and often times do not incorporate the team training. At IMSAL, we are training entire teams of doctors and nurses from all 11 HHC hospitals how to make life saving decisions and improve skills as a team under high pressure conditions. Simulation training allows the entire team to practice, perfect and master procedures and communication skills without risk to patients.
What are your future plans and goals for IMSAL?
The core mission of IMSAL is to improve patient care, which will be achieved by training clinicians more efficiently and effectively. This month IMSAL will host a medical simulation instructor course taught by visiting faculty from Harvard’s Center for Medical Simulation. Eventually, we hope to expand our facility-based simulation programs so that we can reach more staff. I also hope to have HHC’s IMSAL leading the way in simulation training nationally, and I think we are well on our way.